Shots - Health Blog

By Putting Patients First, Hospital Tries To Make Care More Personal

Patient Bob Berquist with Gregory Wagner, a doctor in the emergency department. Berquist, who volunteers at Fauquier Hospital, was admitted for low blood sugar when another nurse noticed he seemed dizzy.

Patient Bob Berquist with Gregory Wagner, a doctor in the emergency department. Berquist, who volunteers at Fauquier Hospital, was admitted for low blood sugar when another nurse noticed he seemed dizzy.

Twice a week, local seniors in Warrenton, Va., flock to the hospital's cafeteria, called The Bistro, for a meal, a great view and musical accompaniment by a retired piano player from a nearby Nordstrom's.

The chefs in the cafeteria try to buy whatever food they can't grow in the garden from farms as close to home as possible.

John RoseNPR

No one likes to go to the hospital.

But some hospitals around the nation are trying to make their patients' stays a little less unpleasant.

They're members of an organization called Planetree, which was founded by a patient named Angelica Thieriot, who had a not-so-good hospital experience back in the 1970s.

"She herself became very ill and was hospitalized," says Planetree President Susan Frampton. "And while she felt she got good clinical quality care, she was really horrified by the human experience that she had. So she founded Planetree with a very lofty goal: to change the health care system to be more patient- and family-centered. And that has been our mission ... for the last three and a half decades."

Today Planetree has certified, or "designated," 30 hospitals and nursing homes in the U.S. and four countries as meeting a specific list of criteria that qualify them as providing truly patient-centered care.

Among the 14 Planetree hospitals in the U.S. is Fauquier Hospital, a 97-bed facility in Warrenton, Va., on the outskirts of Washington, D.C.

CEO Rodger Baker says there was an element of business to his decision to transform his hospital into a more patient-centered place. "We felt it could differentiate us in a market with giants around us," he says.

But mostly he wanted to make the change because he was convinced that something was wrong with the way hospitals were treating patients.

"We put patients in rooms with gowns that don't have backs on them; we strip them of their dignity; we don't explain things to them. And that's really not what they want," he says.

Baker says he first heard of Planetree in the early 1990s. But he had his epiphany while listening to the head of a Planetree hospital in Oregon, Mid-Columbia Medical Center, several years later.

"He talked about all the things they did in that hospital," Baker remembers. "And for some reason it seemed to click with me in terms of it was the right thing to do ... He talked about healing the whole person, dealing with individuals in terms of not just doing the science, but also healing the whole body, in terms of the spirit as well."

Indeed, Fauquier, which achieved its Planetree designation in 2007, offers a wide array of services not usually found in your average hospital.

Not only is every one of its patient rooms a private one, it has food cooked and delivered to order, some from its own organic garden.

The walls are decorated with local art, which is sold monthly to raise funds for the hospital's foundation. And the hallways are carpeted, to keep the noise level down.

"We have massage therapy; we do hand massages," says Lisa Spitzer, the hospital's concierge. "We bake cookies; every week we have volunteers come in once a week for this wonderful vanilla aromatherapy."

Spitzer — whose job is essentially to make sure that patients, staff and families have whatever they need, whenever they need it — describes Fauquier as "having a different energy about it" since it adopted the Planetree model.

Doctors and patients seem to agree.

Interventional radiologist Adam Winick admits he was a skeptic at first.

Winick says he was particularly concerned about doing away with set visiting hours, which among other things gave patients' families open access to the intensive care unit.

"My own little area that I was most worried about was in a code setting when the patient's heart stops. And having the family members standing there watching I felt would traumatize the patients' families, because they don't understand what's going on," he says.

But that hasn't turned out to be a problem after all: The hospital always makes sure a staff member is on hand to explain to the family what's going on in those situations.

Winick also says that communication has improved between patients and staff, and between doctors and nurses as a result of the changes. Poor communication in the hospital was a key complaint in the poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

"It puts everybody in the mindset that I'm doing this for the patient," he says. "A doctor doesn't mistreat a nurse out of anger because he's doing it or she's doing it — asking a question for the patient's benefit."

Patients also seem to appreciate what they see as more personal care.

"It's friendly, it's more like home," says Marianna Traczuk, who's been in and out of Fauquier several times being treated for ovarian cancer. She says she prefers Fauquier to the hospital where she used to get care in Maryland. "It's nice to have someone walk in and say, 'Hi, how are you today?' instead of walking by and acting as if you're invisible."

And Planetree President Susan Frampton says that providing the kind of care that involves patients and their families, and that patients actually want, can cut costs. She says that one hospital system that has some hospitals in the Planetree system and some that aren't compared its orthopedic patients.

"And they found that the length of stay was actually shorter" in the Planetree hospitals, she says. "People healed quicker, they were discharged more quickly, and so the cost of care came down. So [it was] interesting to counter that misbelief that care has to be more expensive if it's done in a patient-centered context, or in a place that's more pleasant to be in."

But health quality experts like Don Berwick, the former head of Medicare, warn that the most important part of places that are designated by Planetree aren't the fancy extras like alternative therapies or fancy food — it's the actual involvement of patients and families in their own care.

"The amenities are nice, of course," he says. "But what really counts in patient-centered care is that the more patients and families and their loved ones participate in their own care, really play an active role in the care itself, the better the care gets. Outcomes get better, costs fall, and satisfaction increases. So this isn't about the amenities; this is about the core of health care."

Berwick and other quality experts also warn that being a patient-centered facility doesn't itself guarantee high-quality care. Patients still have to make sure the medical staff is following proper guidelines for care and getting those good outcomes. But they say that keeping the patient and family highly involved in their care is one important indicator of a good hospital.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

AUDIE CORNISH, HOST:

And I'm Audie Cornish.

And next we examine one of the most important institutions in American life, a place that everyone can agree we need, yet no one wants to visit - the hospital. Once there, one in six Americans now say they're dissatisfied with the quality of medical care they receive. That's according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. A chief concern among those who say they've spent a night or more in the hospital this year, poor communication among doctors and nurses.

Well, one hospital in Virginia is trying to change that, and NPR's Julie Rovner takes us there.

JULIE ROVNER, BYLINE: Roger Baker says he's known as far back at the early 1990s that something wasn't right with the way hospitals were treating patients. Baker is also a doctor and CEO of Fauquier Hospital, in Warrington, which is about 50 miles outside Washington, D.C.

DR. ROGER BAKER: What essentially America was saying is that we're fed up with the impersonalization of medical care. We put patients in rooms with gowns that don't have backs on them. We strip them of their dignity. We don't explain things to them. And that's really not what they want.

ROVNER: But Baker says it wasn't until he met the leader of a hospital from Oregon several years later that a plan began to take shape. That Oregon hospital belonged to a group called Planetree. It was founded by an unhappy patient in the late 1970s to make hospital care more attentive to patients' wants and needs.

BAKER: He talked about all the different things that they did. And for some reason it seemed to click with me, in terms of it was the right thing to do, it's really what patients want wanted. He talked about healing the whole person, you know, dealing with individuals in terms of not just doing the science but also healing the whole body, and in terms of the spirit as well.

ROVNER: At the time, Fauquier was just about to launch a $75 million project to rebuild the hospital. Baker decided to launch a cultural change, as well. Today, you just have to walk through the doors to see that change in action.

(SOUNDBITE OF PIANO MUSIC)

ROVNER: The cafeteria known as the Bistro on the Hill, features live music, including a piano player who once worked at a nearby Nordstrom's department store. Just outside, there's an organic garden.

ZACK ERICKSON: We have a whole bed here of beautiful herbs which have been featured in our cafeteria and patient meals today.

ROVNER: Patient meals that are cooked to order, not just delivered from a cart, says Zack Erickson, Fauquier's head of nutrition. Inside the hospital, there's art on the walls, carpets on the hallways to keep the noise level down, and soothing lighting rather than harsh fluorescents. Even in the emergency room, the care is, well, personal.

RHAMES: And I'll find out who's - who the doctors are tomorrow. I'll give you their names so that when you show up, you'll recognize their name and then they'll be able to pull up your chart.

HALE: OK.

ROVNER: Hale, who lives nearby but actually travels to a university center for her cancer treatment, is the rare patient who doesn't rave about Fauquier's care.

HALE: No, just I would say smaller.

ROVNER: But other patients, like Gary Louden((ph) say they like the fact that Fauquier - at 97 beds - isn't what some staff members referred to derisively as a big-box hospital. He says he felt more than well taken care of when he had shoulder surgery a couple of years ago.

GARY LOUDEN: It just seems like it's a lot more family oriented and caring here than maybe some of the other bigger centers.

ROVNER: What the hospital is providing is what patients seem to want. Fauquier's market share has grown nine percent since it won certification from Planetree in 2007. And patient satisfaction scores have improved, too. Unlike many larger hospitals, Fauquier doesn't charge extra for fancy food or private rooms.

CEO Baker says that moving to more patient-centered care actually prevents problems that end up making care more expensive.

BAKER: If a patient falls and breaks something, that's costly for the organization. If the patient is upset about something and their pain isn't managed well, they're going to complain about that. I mean, they may be in the hospital a day longer, which is costly.

ROVNER: But what's most important about Planetree and patient-centered care aren't things like organic food or quieter hallways, says Don Berwick. It's the idea of involving the patient and their families more in their own care. Berwick is the former head of the Medicare program and an expert on health quality.

DR. DON BERWICK: The amenities are nice, of course. But what really counts in patient-centered care is that the more patients and families and their loved ones participate in their own care, really play an active role in the care itself, the better the care gets. Outcomes gets better, costs fall and satisfaction increases.

ROVNER: Of course, making a hospital truly patient-centered requires a big change on the part of the people providing that care. That wasn't easy at Fauquier. Over in a cramped treatment room, interventional radiologist Adam Winick is finishing up with his last patient of the day. He's using a balloon to remove a blood clot from a man's leg, letting him walk without pain.

DR. ADAM WINICK: And this is the muscle group here that feeds the outside of the thigh. And that blood vessel is open...

ROVNER: Winick says that one of the things that bothered him when the hospital moved to patient-centered care was eliminating set visiting hours. Among other things, that allowed patients' families unlimited access to the ICU. He was worried about what would happen when a patient's heart stopped and the resuscitation team rushed in.

WINICK: And having the family members standing there watching, I felt would traumatize the patient's families because they don't understand what's going on.

ROVNER: But Winick says when that happens a staff member is always assigned to explain to the family what's happening. So it hasn't been a problem after all. Winick also says putting patients at the top of the pyramid has improved communication between members of the medical staff.

WINICK: It puts everybody in the mindset that I'm doing this for the patient. And the doctor doesn't mistreat a nurse out of anger because she's doing it or he's doing it, you know, asking a question for the patient's benefit.

ROVNER: Berwick and other quality experts warn that being a patient-centered facility doesn't guarantee high-quality care. Patients still have to make sure the medical staff is following proper guidelines for care and getting good outcomes. But they say that keeping the patient and family highly involved in their care is one indicator of a good hospital.

Julie Rovner, NPR News.

CORNISH: For more on what people said about the quality of their care, go to NPR.org. Transcript provided by NPR, Copyright NPR.